Temporal lobe seizures originate in the temporal lobes of your brain, which process emotions and are important for short-term memory. Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings — such as euphoria, deja vu or fear.
During a temporal lobe seizure, you may remain aware of what's happening. During more-intense seizures, you might look awake but be unresponsive. Your lips and hands may make purposeless, repetitive movements.
Temporal lobe seizures may stem from an anatomical defect or scar in your temporal lobe, but the cause is often unknown. Temporal lobe seizures are treated with medication. For some people who don't respond to medication, surgery may be an option.
An unusual sensation (aura) may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures has auras, and not everyone who has auras remembers them.
The aura is actually a simple partial or focal seizure — one that doesn't impair consciousness. Examples of auras include:
- A sudden sense of unprovoked fear
- A deja vu experience — a feeling that what's happening has happened before
- A sudden or strange odor or taste
- A rising sensation in the abdomen
Sometimes temporal lobe seizures impair your ability to respond to others (partial complex or focal dyscognitive seizures). This type of temporal lobe seizure usually lasts 30 seconds to two minutes. Characteristic signs and symptoms include:
- Loss of awareness of surroundings
- Lip smacking
- Repeated swallowing or chewing
- Unusual finger movements, such as picking motions
After a temporal lobe seizure, you may have:
- A period of confusion and difficulty speaking
- Inability to recall what occurred during the seizure
- Unawareness of having had a seizure
- Extreme sleepiness
In extreme cases, what starts as a temporal lobe seizure evolves into a generalized tonic-clonic (grand mal) seizure — featuring convulsions and loss of consciousness.
When to see a doctor
Seek medical advice in these circumstances:
- If you think your or your child is having seizures
- When the number or severity of seizures increases significantly without explanation
- When new signs or symptoms of seizures appear
Seek emergency medical care if:
- A seizure lasts more than five minutes
- The person doesn't recover completely or as quickly as usual after the seizure is over
- Seizures keep repeating in a single day
Often, the cause of temporal lobe seizures remains unknown. However, they can be a result of a number of factors, including:
- Traumatic brain injury
- Infections, such as encephalitis or meningitis, or history of such infections
- A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
- Blood vessel malformations in the brain
- Brain tumors
- Genetic syndromes
During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronized, a convulsion or seizure may occur.
If this happens in just one area of the brain, the result is a focal seizure. A temporal lobe seizure is a partial seizure that originates in one of the temporal lobes.
Over time, repeated temporal lobe seizures can cause the part of the brain that's responsible for learning and memory (hippocampus) to shrink. Brain cell loss in this area may cause memory problems.
You'll likely start by seeing your family doctor or a general practitioner, then you'll likely be referred to a doctor who specializes in nervous system disorders (neurologist).
Here's some information to help you prepare for your appointment.
What you can do
- Write down symptoms you or your child has had, including those that may seem unrelated to seizures. Note the kinds of seizures. For example, do some affect the left side of the body more than the right or vice versa? Do some affect speech and others not?
- Make a list of all medications, vitamins and supplements you or your child is taking and the dosages. Write down the reasons — whether side effects or lack of effectiveness — you stopped taking any.
- Ask a family member to accompany you to help you remember what you're told during your appointment. Also, since memory loss can happen during seizures, an observer may be able to describe the seizures better than you can.
- Have a family member or friend video record the seizure with a cellphone or other video recorder, if possible.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. For temporal lobe seizure, some questions to ask include:
- Is the diagnosis epilepsy?
- Will more seizures occur? Will different types of seizures occur?
- What tests are needed? Do these tests require special preparation?
- What treatments are available, and which do you recommend?
- What types of side effects can I expect from treatment?
- Is surgery a possibility?
- Should I restrict activities? What safety issues do I face?
- Is my condition potentially fatal? How do I minimize the risks caused by my condition?
- Is there a generic alternative to the medicine you're prescribing?
- Do you have brochures or other printed materials I can take? What websites do you recommend?
Don't hesitate to ask any other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you or your child begin having symptoms?
- Did you notice any unusual sensations before the seizures?
- How often do seizures occur?
- Can you describe a typical seizure?
- How long do the seizures last?
- Do the seizures occur in clusters?
- Do they all look the same or are there different seizure behaviors you or others have seen?
- Does your or your child's head or body turn in one direction during a seizure?
- Does the seizure affect speech during its early phase?
- Have you or your child been injured during a seizure?
- How would you describe you or your child right after the seizure?
- What medications have you or your child tried? What doses were used?
- Have you tried combining medication?
- Have you noticed seizure triggers, such as sleep deprivation or illness?
Your doctor will need a detailed description of the seizures, preferably from a witness, because most people who have temporal lobe seizures don't remember the episodes.
If you or your child has had a seizure, your doctor likely will perform a neurological exam that tests:
- Muscle tone
- Muscle strength
- Sensory function
He or she may also ask questions to assess your thinking, judgment and memory.
Blood tests and scans
Blood tests may be ordered to check for problems that could be causing or triggering the seizures.
Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.
Electroencephalogram (EEG). An EEG displays the electrical activity of your brain as recorded by electrodes attached to your scalp. People with epilepsy often have changes in their brain wave patterns, even when not having a seizure. The EEG sometimes can help indicate the type of seizures you're having.
In some cases, your doctor may recommend video-EEG monitoring in the hospital. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern. This can help your doctor pinpoint the type of seizure disorder you have, which helps to identify appropriate treatments, and can help ensure that the seizure diagnosis is correct.
Magnetic resonance imaging (MRI). An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, certain MRI abnormalities may provide a clue to the cause of the seizures.
During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilized in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine's close quarters. If you think you may have this reaction, tell your doctor before the study.
Single-photon emission computerized tomography (SPECT). Sometimes used when the area of seizure onset is unclear, SPECT imaging requires two scans — one during a seizure and one during a nonseizure period, each performed on separate days. Radioactive material is injected for both scans.
The scans are then compared to find the area of the brain with the greatest activity during the seizure. The resulting image is then superimposed onto the MRI. This is used with EEG information to help guide the surgeons.
Numerous medications are available to treat temporal lobe seizures. However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common.
Discuss possible side effects with your doctor when deciding about treatment options. Also ask what effect your seizure medications and other medications you take, such as oral contraceptives, may have on each other.
If you have temporal lobe seizures that don't respond to medication, you may be evaluated for surgery. For some people, surgery eliminates or greatly reduces the number of seizures.
However, as with any surgery, surgery for seizures carries risks. It may not be successful, and it can result in neurological problems. Discuss the possible risks with your neurologist and surgeon.
Surgery is generally not an option if:
- Your seizures come from a region of the brain that performs vital brain functions
- Your seizures come from more than one area
- Your seizure focus can't be identified
Preparing for surgery
Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.
Before surgery, you'll need:
- A comprehensive evaluation
- MRI scans of your brain
- Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG
Most people need to continue taking medication to help ensure that seizures don't recur. However, if surgery appears successful, medications can sometimes be reduced and occasionally discontinued.
Vagus nerve stimulation
A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck.
The device turns on and off according to an adjustable program and can be activated with a magnet. The device doesn't detect seizures. It's usually well-tolerated, but it's not a replacement for medication.
The Food and Drug Administration (FDA) has approved a device for treating seizures that don't respond to medication. The device detects seizure activity and delivers an electrical stimulation to the detected area. The device is implanted on the surface of the brain or within the brain tissue, and attached to a battery-powered generator, which is implanted in the skull, close to the brain.
Deep brain stimulation
Deep brain stimulation involves implanting electrodes into a part of the brain called the thalamus. This treatment is not currently FDA-approved for treatment of seizures. In highly selected cases, it may be beneficial in treating seizures that don't respond to medication. More study is needed.
Pregnancy and seizures
The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, certain medications, such as valproic acid (Depakene), taken during pregnancy are known to increase the risk of birth defects.
Seizures pose a risk to a developing baby, so it's generally not recommended to stop medications during pregnancy. Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.
If you take medication for seizures and might become pregnant, taking prescription folic acid daily before you become pregnant can help prevent birth defects related to seizure medication.
The risk of birth defects is considered to be higher in women taking more than one drug. If your seizures can't be well-controlled with other medication, discuss the potential risks with your doctor.
Contraception and anti-seizure medications
Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if you should consider other forms of contraception.
Certain activities can be dangerous if you have a seizure while doing them. Activities include:
- Swimming. If you go in water, don't go alone and be sure to wear a life preserver.
- Bathing. Bathing also can pose a risk of drowning. Shower instead.
- Working high up. You could fall during a seizure.
- Driving a car or operating other equipment. All states have licensing restrictions for driving for people with a history of seizures. The rules differ from state to state.
Consider wearing a medical alert bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and your medication allergies.
Even after they're under control, seizures can affect your life. Temporal lobe seizures may present even more of a coping challenge because people may not recognize the unusual behavior as a seizure. Children may get teased or be embarrassed by their condition, and living with the constant threat of another seizure may frustrate children and adults.
You may find it helpful to talk with others in similar situations. Besides offering support, they may have advice or tips for coping you haven't thought of.
The Epilepsy Foundation has a network of support groups, as well as online forums for teens and adults who have seizures and for parents of children who have seizures. You can reach the foundation at 800-332-1000 or visit the foundation website. You can also ask your doctor if he or she knows of any support groups in your area.
June 25, 2014
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